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Randomized Controlled Trial
. 2023 Jul;38(Suppl 3):878-886.
doi: 10.1007/s11606-023-08114-6. Epub 2023 Jun 20.

Effect of a National VHA Medical Scribe Pilot on Provider Productivity, Wait Times, and Patient Satisfaction in Cardiology and Orthopedics

Sivagaminathan Palani  1   2 , Iman Saeed  1   2 , Aaron Legler  1 , Izabela Sadej  1 , Carol MacDonald  1 , Susan R Kirsh  3 , Steven D Pizer  1   2 , Paul R Shafer  4   5
Affiliations
Randomized Controlled Trial

Effect of a National VHA Medical Scribe Pilot on Provider Productivity, Wait Times, and Patient Satisfaction in Cardiology and Orthopedics

Sivagaminathan Palani et al. J Gen Intern Med. 2023 Jul.

Abstract

Background: Section 507 of the VA MISSION Act of 2018 mandated a 2-year pilot study of medical scribes in the Veterans Health Administration (VHA), with 12 VA Medical Centers randomly selected to receive scribes in their emergency departments or high wait time specialty clinics (cardiology and orthopedics). The pilot began on June 30, 2020, and ended on July 1, 2022.

Objective: Our objective was to evaluate the impact of medical scribes on provider productivity, wait times, and patient satisfaction in cardiology and orthopedics, as mandated by the MISSION Act.

Design: Cluster randomized trial, with intent-to-treat analysis using difference-in-differences regression.

Patients: Veterans using 18 included VA Medical Centers (12 intervention and 6 comparison sites).

Intervention: Randomization into MISSION 507 medical scribe pilot.

Main measures: Provider productivity, wait times, and patient satisfaction per clinic-pay period.

Key results: Randomization into the scribe pilot was associated with increases of 25.2 relative value units (RVUs) per full-time equivalent (FTE) (p < 0.001) and 8.5 visits per FTE (p = 0.002) in cardiology and increases of 17.3 RVUs per FTE (p = 0.001) and 12.5 visits per FTE (p = 0.001) in orthopedics. We found that the scribe pilot was associated with a decrease of 8.5 days in request to appointment day wait times (p < 0.001) in orthopedics, driven by a 5.7-day decrease in appointment made to appointment day wait times (p < 0.001), and observed no change in wait times in cardiology. We also observed no declines in patient satisfaction with randomization into the scribe pilot.

Conclusions: Given the potential improvements in productivity and wait times with no change in patient satisfaction, our results suggest that scribes may be a useful tool to improve access to VHA care. However, participation in the pilot by sites and providers was voluntary, which could have implications for scalability and what effects could be expected if scribes were introduced to the care process without buy-in. Cost was not considered in this analysis but is an important factor for future implementation.

Trial registration: ClinicalTrials.gov Identifier: NCT04154462.

Keywords: MISSION Act; Patient satisfaction; Productivity; Scribes; Veterans; Wait times.

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Conflict of interest statement

The authors have no conflicts of interest to declare. The views expressed in this article are those of the authors and do not necessarily reflect the position or policy of the Department of Veterans Affairs or the United States government.

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References

    1. U.S Department of Veteran Affairs. National Center for Veteran Analysis and Statistics. Available at: https://www.va.gov/vetdata/veteran_population.asp. Accessed October 3, 2022.
    1. U.S Department of Veteran Affairs. VA MISSION Act: VA’s new urgent care benefit for Veterans. Available at: https://news.va.gov/60896/va-mission-act-vas-new-urgent-care-benefit-for.... Accessed October 3, 2022.
    1. U.S. Department of Veteran Affairs. Concerns with Consistency and Transparency in the Calculation and Disclosure of Patient Wait Time Data. Available at: https://www.va.gov/oig/pubs/VAOIG-21-02761-125.pdf. Accessed October 3, 2022.
    1. U.S Department of Veteran Affairs. VA announces final community care regulations under MISSION Act. Available at: https://news.va.gov/61258/va-announces-final-community-care-regulations-.... Accessed October 3, 2022.
    1. Shane L. VA secretary promises improvements in medical wait time data. Available at: https://www.militarytimes.com/veterans/2022/04/08/va-secretary-promises-.... Accessed October 3, 2022.

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